CARE HOMES FOR OLDER PEOPLE
Avenue Nursing Home Avenue Nursing Home 32 The Avenue Cheam Surrey SM2 7QB Lead Inspector
Alison Ford Unannounced Inspection 12th January 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Avenue Nursing Home Address Avenue Nursing Home 32 The Avenue Cheam Surrey SM2 7QB 020 8642 3912 020 8642 3912 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Avenue Nursing Home Ltd *** Post Vacant *** Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. One service user may be aged 55 plus years. A registered manager must be in post within 6 months. The building works as per plans submitted must be completed within six months. 20th October 2005 Date of last inspection Brief Description of the Service: Avenue Nursing Home is an older style detached property situated in an attractive residential area of Cheam. It is registered with The Commission for Social Care Inspection to provide nursing care for up to twenty people over the age of sixty-five although there is currently a variation in place to allow one younger resident to live there. Accommodation is arranged over two floors with toilets and bathrooms on each floor and there is a passenger lift. Historically the home had been the subject of many concerns and repeated requirements, due to a significant lack of investment. However it was sold last year and is currently undergoing major structural modifications and complete refurbishment and redecoration. Recruitment procedures, staffing issues and policies and procedures designed to protect the safety of residents and staff are being brought into line with other homes owned by this provider. This is beginning to provide a much more pleasant environment for both its residents and staff which complies with current health and safety legislation. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second inspection for the year 2005/2006 although several additional visits have also been made throughout that time. These had been to check on the progress of the work being undertaken since the home was sold to its current owner Mr Patel. This inspection was unannounced although the visit had been scheduled to look at staff files. It was conducted over five hours and included a tour of the premises, inspection of staff files and an assessment of a number of care plans and the medication procedures and storage. The majority of the residents were spoken with during the visit and six members of staff. The extensive renovation and refurbishment of the home is still underway, the new management arrangements are still being put into place and recruitment procedures and health and safety policies are being updated in line with the owners other homes. Consideration has therefore been given to this during the inspection process. The home still has no registered manager and management issues are currently being overseen by Mrs P Reid who is the registered manager in one of the owners other homes. Over the course of the two inspections all of those standards, considered by The Commission to be key to the inspection process, have been assessed and this report should be read in conjunction with the one produced following the visit on 20th October 2005. What the service does well:
Despite all the problems being experienced during this time of new management and refurbishment the majority of care staff have continued to provide good quality care to the residents all of whom looked well cared for. Comments made by residents that were spoken with included “staff are mostly very kind and willing to help” and “they know how I like things done”. Residents said that they enjoyed the activities that took place and agreed that the food served was very good. All of the residents are enjoying seeing all the renovation work that is being done and agree how much better it is looking. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The home is still without a registered manager and in order to provide stability in the home this must now be addressed. The Registered Provider will need to submit an application for a suitable person to be appointed within the next three months. The Statement of Purpose, Service User Guide and complaints procedures have been updated however, a method must now be found to make these documents available to both present and prospective residents and their relatives. Some amendments are also required to include the latest inspection report and views of residents in order for them to make an informed choice as to the suitability of the home. In addition, the pre-admission assessment needs to be further developed to ensure that the home can be sure that potential residents healthcare needs can be met. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 7 It is to be hoped that the employment of the new clinical tutor will facilitate staff training in the home however the Registered Provider will still need to submit an action plan detailing how he will ensure that 50 of care staff are going to undertake an NVQ level 2 qualification. In order to ensure that residents and their relatives are able to comment and influence the provision of care in the home, a quality assurance monitoring tool needs to be introduced. It is the intention to develop one method into all of the homes owned by The Provider although it was suggested that until this time there should be an effort made to hold meetings for the residents and their families in order to gather their views. Although the majority of concerns, raised previously by the Fire Safety Officer, have been complied with, automatic door closers that operate in the event of a fire still need to be fitted to bedroom doors. It is understood that there are plans for this to happen in order to increase resident’s safety. The management team have been working hard to ensure that staff files contain all of the documentation required to show that appropriate checks have been carried out to protect the residents. Despite this, some of the evidence is still not available and a return visit will be made after four weeks to make sure that this has been done. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 Residents are not always able to access the information that would allow them to be certain that the home will meet their needs. A pre-admission assessment is undertaken however this would benefit from further development, so that potential residents can be sure that the home can meet their assessed healthcare needs. This home does not offer intermediate care. EVIDENCE: A new Statement of Purpose and Service User Guide has been produced for the home, and were seen at the inspection, and a new brochure is currently being compiled. Discussion was undertaken with the management team as to how the Statement of Purpose might be displayed in the hall and the Service User Guide distributed, to make them accessible to current and potential residents and their families. They must also be presented in a way, which will allow a copy of the latest inspection report and residents views of the home to be incorporated.
Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 10 The homes complaints procedure must also be made freely available to all residents and their families so that they are able to understand the procedures to be followed and the timescales in which their concerns will be responded to. An assurance was given that all of these documents could be made available in different formats, such as large print or an alternative language, if required to suit the individual needs of residents. A copy of the new contract that is supplied to residents was seen and this confirms the obligations of both the home and the potential resident. A copy of the pre- admission assessment tool was seen and, although it was a commercially produced document, it was felt that some additional work was required to ensure that it would assess all aspects of a residents psychosocial needs and make it more reflective of the care and support that was required. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 All residents have an individual care plan which details the support that they require and provides evidence that advice is sought from other health care professionals to ensure that care meets their assessed needs. Residents can be sure that they will always be treated in a way, which respects their dignity, and privacy and that they are protected by the homes medication procedures. EVIDENCE: Residents all have an individual care plan and a sample of these were seen. They set out the interventions currently required to support the residents and meet their healthcare needs however, they would benefit from more detailed recording of the actual care that is given. This was discussed with the homes acting manager and new clinical tutor. There is evidence that advice is gained from other healthcare professionals and regular monitoring and review identifies those at risk from developing pressure sores. Suitable equipment, such as pressure relieving mattresses, was seen throughout the home for these residents. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 12 Medication records and storage were viewed and were found to be orderly and the procedures that are in place are designed to protect residents. Trained nurses administer all medication in the home. Staff were observed to be treating residents with respect and dignity and those that were spoken with, agreed that staff were always “ very kind “ and “very nice to them”. Staffing levels are sufficient to allow carers to spend time talking with residents and helping them with activities. All personal care is delivered in resident’s own rooms. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15 The range of activities in the home are suitable for the residents living there, adding interest to their daily lives and visitors are always welcome so that family contacts and friendships can be continued. Residents are encouraged to make choices where possible in order to retain their independence and they receive a nutritious balanced diet, which maintains their health and wellbeing. EVIDENCE: A range of activities is offered in the home, mainly by staff, and residents are able to choose whether or not they wish to participate. They have been encouraged to bring personal possessions into the home to make their bedrooms more homely however none of them are currently able to look after their own financial affairs. The regular cook was away on the day of this inspection however, residents were generally happy with the food that is served in the home. Comments were received that “meals are generally very good” and “there is always plenty to eat“ A hot snack supper is prepared by the cook and available for those who would like it.
Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Although residents and their relatives can be confident that their concerns and complaints will be taken seriously they are not always made aware of the procedures to be followed which would make this possible Residents cannot always be sure that procedures are in place, which will, protect them from abuse. EVIDENCE: There is a newly developed complaints procedure, which clearly sets out the procedures to be followed however; it is not clearly displayed in the home for residents and their relatives to see. A requirement is issued for this to be rectified under standard 1. Policies concerned with adult abuse are in place however; recruitment checks do not always contain evidence that appropriate clearance has been gained for new members of staff prior to employment. This is highlighted in standard 29. There has been one incident since the last inspection, which is being investigated under the Vulnerable Adults Procedure and is still ongoing. All of the residents spoken with agreed that staff were very kind and caring. Training in issues around abuse and the protection of vulnerable adults must be included in the planned teaching programme. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents are confident that the extensive improvements being made to the home will result in a clean, safe well maintained environment for them to live in however, there are still some concerns about their safety in the event of a fire. EVIDENCE: An extensive refurbishment plan is still in progress throughout the home. Both communal areas and resident’s bedrooms are being redecorated. Carpets and furniture are being replaced and washbasins are being put into all the bedrooms. This is creating a much, more pleasant environment for residents. Following the requirements of the fire safety officer, bedroom doors have been replaced however; magnetic door catches, which would close them automatically in the event of a fire, have still not been put onto all of them to ensure the safety of residents. The home would still not meet the requirements highlighted by a previous occupational therapists report however; planning permission is still awaited for further improvements. The residents have watched all the work with interest
Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 16 and commented on how good it was all looking now and staff said that they appreciate the new environment. Despite all of the ongoing work the home was clean and tidy and free from malodour on the day of inspection Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 There are sufficient staff on duty to ensure that residents needs will be met however, they cannot be sure that staff are always appropriately trained or that recruitment procedures are in place to ensure their protection. EVIDENCE: On the day of inspection there were sufficient numbers of care staff on duty to be free to sit in the lounge with residents, talk to them and help them and this was in addition domestic staff. Files of all the current members of staff were inspected and some did not include evidence of clearance from The Criminal Records Bureau. An immediate requirement was issued that evidence that this clearance had been applied for must be available within the next four weeks. Staff training is an area that still needs to be addressed and the newly appointed clinical teacher is undertaking a training needs analysis. It is intended that various sessions will be arranged across the group of homes. No members of staff are in possession of an NVQ qualification although two have started the course. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Management arrangements in this home are not sufficient to ensure its smooth running and residents are not given the opportunity to influence the care and services that are provided however, they can be assured that their financial interests are always protected. There is no evidence that all equipment has been maintained to a standard that will ensure the protection of residents and arrangements are not in place to provide appropriate supervision to staff. EVIDENCE: The home is still without a registered manager. Interim arrangements have been introduced and these have worked well however, to ensure continuity and the smooth running of the home an application for registration must be submitted for a suitable person within the next three months. Residents currently do not have the opportunity to contribute to the running of the home as there is no forum available for them to express their views. It is
Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 19 intended that a quality assurance system will be introduced into all the homes within this group and this must be done within the next three months. It was recommended that the process could be started by the introduction of residents and relatives meetings before this time. Staff supervision and appraisal is still to be implemented within the home and it is intended that the homes new clinical tutor will be organising this in the near future. A requirement is issued that this should be for all staff and at least six times a year for care staff. No resident is currently able to look after their own finances and they all have a friend or relative that is undertaking this for them. Certificates of worthiness for equipment were seen and not of all those that are required were present. Copies of those relating to bacterial water analysis, PAT, electrical safety and gas will need to be sent to the office of The Commission for Social Care Inspection. A requirement, that all staff that prepare food, must also have a valid basic Food Hygiene Certificate is also repeated. Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(2) Requirement The Registered Provider must ensure that The Statement of Purpose and Service User Guide are made available to all current and potential residents and their relatives. The Registered Provider must ensure that The Statement of Purpose includes a copy of the last inspection report and Service Users views of the home. The Registered Provider must ensure that the complaints procedure is made available to all current and potential residents and their relatives. The Registered Provider must ensure that the pre-admission assessment document is developed to include all aspects of potential residents psychosocial needs and is reflective of the support and care that is required. The Registered Provider must ensure that entries in care plans are reflective of the care that is actually delivered The Registered Provider must
DS0000063984.V276319.R01.S.doc Timescale for action 30/04/06 2 OP1 4(1)(c) 4 (2) 30/04/06 3 OP1 4(1)(c) 4 (2) 30/04/06 4 OP3 14(1)(a) 30/04/06 5 OP7 17(1)(a) 30/04/06 6 OP18 18(1)(c) 30/04/06
Page 22 Avenue Nursing Home Version 5.1 ensure that all staff receive training in adult abuse awareness and the procedures to be followed. 7 OP19 13(4)(c) The Registered Provider must ensure that, where resident wish their doors to remain open, they are fitted with a closing device, which operates in the event of a fire. The Registered Provider must ensure that satisfactory clearance from the Criminal Records Bureau has been received for all staff. (Immediate requirement issued) The Registered Provider must ensure that there is evidence that all staff have received training appropriate to their needs and the role that they undertake. The Registered Provider must submit an action plan detailing how at least 50 of staff will complete an NVQ level 2 qualification. The Registered Provider must ensure that an application is received for a suitably qualified person to be registered as the homes manager. The Registered Provider must ensure that a quality assurance monitoring tool is introduced into the home The Registered Provider must ensure that staff supervision is introduced into the home for all staff and for care staff at least six times a year. The Registered Provider must ensure that copies of certificates of worthiness for electricity and electrical safety, gas, PAT, call bells and bacterial water analysis
DS0000063984.V276319.R01.S.doc 30/04/06 8 OP29 19(1) (b) 09/02/06 9 OP30 18(1)(c) 30/04/06 10 OP30 18(1)(c) 30/04/06 11 OP31 18(1)(a) (I)(iii) 30/04/06 12 OP33 24(1) (A)(b) 18(2) 30/04/06 13 OP36 30/04/06 14 OP38 13(4)(c) 30/04/06 Avenue Nursing Home Version 5.1 Page 23 15 OP30 13(4)(c) are sent to the office of The Commission for Social Care Inspection The Registered Provider must ensure that any member of staff involved in preparing or serving food has a valid food hygiene certificate. (Previous timescale 30/01/06 extended) 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Avenue Nursing Home DS0000063984.V276319.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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